canker sores

Nurses General Nursing

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I've had a rash of patients lately that have had terribly sore mouths. Some from antibiotics, some from stomatitis, and some from an exacerbation of psoriasis. Most look like canker sores, definately not thrush. These people really suffer!

We've gone through the hydrogen peroxide/lidocaine swishes and spits to the troches. Nothing is helping.

Do you know of any medicinal (Dr. would have to order) or non-medicinal treatments (that a nurse could use without an order) that may make these patients more comfortable?

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

Re: TriageRN 34 response

"For those WITHOUT chronic probelms in the mouth I say stick it out and deal with a bit of discomfort for a part of the anatomy you have used and abused for umteen years that finally has a probelm. It will heal, and a few days of discomfort vs a livetime of servitude....hm?"

"Those with bigger probelms...I have NEVER seen any mouthwash or magic mouthwash that has helped when their natual immunity couldn't faster."

Magic mouthwash, viscous lidocaine, and Kenalog/OraBase all are helpful. A bit of discomfort to you, might be horrible pain to someone else. These problems are common for those with HIV/AIDS, and their natural immunity isn't helping them out much. Obviously you have never had a mouth full of canker sores (or if you have, your stoicism is amazing!)

I know this won't be relevant to your patients but may be of some help to our members.

My recurrent canker sores seemed to be coming from my wisdom teeth.

I went to the dentist because I was totally fed up with them. I think I had the sores for about 11 weeks by then. I would have several at a time in various stages of healing. I tried anything I could get my hands on-anbusol, Canka, salt swishes, and hydrogen peroxide gargles- nothing really helped.

Anyway, when I had my wisdom teeth removed the sores stopped.

I sympathize!

Specializes in Med Surg, Telemetry, Orthopedics.

An idea, as well, for non-patients - L-Lysine is a natural therapy that has always helped me. At the first "tingle", I take 500-1000 mg several times a day, and increase my consumption of foods with it as well (like tomatoes). This will prevent it from even erupting, even in times of stress!

Specializes in Government.

I've had chronic canker sores since I was a child (I'm now 51). I've got a hefty pain tolerance but I find these horrible. Mine take about 2 weeks to heal. I almost always have one somewhere in my mouth.

I've used every OTC thing and none of them really helped. I had a new dentist a few years ago and he gave me a sample of aphthasol. It is the only thing I have ever used that works. It cuts healing time to about 3 days for me. It comes in a paste and is a little fussy to apply but it has been worth it for me.

It is a prescription product. Not cheap although my drug plan covers it. I've had to tell other dentists what it is as many have never heard of it.

Specializes in Peds, GI, Home Health, Risk Mgmt.
i've had a rash of patients lately that have had terribly sore mouths. some from antibiotics, some from stomatitis, and some from an exacerbation of psoriasis. most look like canker sores, definately not thrush. these people really suffer!

we've gone through the hydrogen peroxide/lidocaine swishes and spits to the troches. nothing is helping.

do you know of any medicinal (dr. would have to order) or non-medicinal treatments (that a nurse could use without an order) that may make these patients more comfortable?

"aphthous ulcers are also known as canker sores. they are painful, temporary sores that may occur anywhere in the mouth except on the gums, lips, or roof of the mouth. they can occur one at a time or as a group of sores. no one knows what causes aphthous ulcers. it is a common misconception that they are a form of the herpes virus."

http://www.med.nyu.edu/patientcare/library/article.html?chunkiid=11983

see also

http://www.patient.co.uk/showdoc/23068855/

http://www.aafp.org/afp/20000701/149.html

[url=http://www.patient.co.uk/showdoc/23068855/][/url]

hollyvk

Specializes in Med/Surge, ER.

One of our docs uses a 1/2 maalox, 1/2 benedryl mixed together, and instructs patients to apply with a q-tip as needed for pain. It works great!! I make it for my husband who has always had severe ulcers. The mixture is thick and creates kind of a protective coating.

I've gotten canker sores when under alot of stress or a change in diet, like if I've eaten too much junk food, or fast foods, and not regular balanced meals with veggies. A nurse I worked with once got canker sores and she went down to the emergency dept and got some kind of stick that looked like a long match stick with a silver tip. She wet the tip and touched the end to the canker. I thought she was crazy, but on the occasion when I got a mouth full of them, I did the same thing. I think it was a silver nitrate stick. I wet the tip and burned every sore in my mouth and they went away. I burned my lip on hot pizza some time later and developed a huge painful sore and I did the silver matchstick trick again and it worked.

Specializes in NICU.

I've been plagued with canker sores (aka mouth ulcers in the UK) since I was a child. If I bite my lip, that turns into one. Sometimes it helps if I rinse my mouth with salt water or 1/2 strengh Hydrogen Peroxide.Sometimes I'll get one on my gum after I've had my teeth cleaned.

I've tried all kinds of treatments, but there is no real cure. Lately, I have used Kanka, which helps but leaves a nasty coating in my mouth, or some dental paste that my dermatologist prescribed. It's Triamcinolone Acetonide Dental Paste USP 0.1%. I think that works quite well, but I need two or three little tubes, not one that I can't find!

Thanks for all your responses!

I cornered one of our Docs while in a pt. room and had him do a pretty thorough examination of this particular pt.'s mouth. He started the same old, "Well, it'll get better when, blah, blah, blah....", speech and I said, "Ya know, this has been going on a long time. This pt. hasn't been able to eat and can barely stand to drink for X days/weeks. Her pain complaints are almost always due to the mouth sores. It's almost unbearable." The pt. was then empowered to tell the Doc just what she'd been telling us!

After looking, this Doc asked what I'd recommend. Well, thanks to all of you I wasn't at a loss for good, solid answers.

He ordered the Zinc lozenges for one pt. and a day later on rounds she thanked him since her mouth was feeling so much better!

Not sure what the Doc ordered for the next pt. as he was transfered. He did say, however, that he would be addressing the situation.

Yea, Nurses are great! YOU ARE GREAT!

I have suffered with canker sores since I was a child, usually after biting the inside of my cheek, scraping with a toothbrush or dental tool, or biting my lip while I was having surgery. KENALOG IN ORABASE is a MIRACLE !! My brother who is a physician recommended it to me and I have been using it for 20 years . After my hysterectomy last year, I had a sore on my inner lip where I bit it while I was sedated. I asked my GYN to order it for me . She hadn't heard about it. I put in on the sore at bedtime and by the morning it's starting to heal !

I get canker sores every once in a while as well, usually they show up near where the gum and the lip meet. I havnt seen anyone else mention my preferred relief, so I'll share. When I get one, I swish listerine. It seems to fatigue the nerve endings so that it completely takes away the pain. For some reason beyond me, after swishing with listerine, the relief lasts almost an entire day. I'm not sure if something in the listerine hangs around in the tissues or what but it works great for me. I've tried the numbing gel, they are hard to apply and only work for like 20 minutes.

Something I found recently is a product called DeBacterol.

It is a sulfuric acid/phenolics solution that acts as a liquid cautery of the immediate nerve endings of the canker sore. It stings upon application but not more so than anbesol or camphophenique IMO. It forms a milky scab that allows for epithelialization while protecting the underlying tissues. I have used it, if treated properly the sore does not hurt any longer and you can literally see healing taking place a few hours later. It says not for use on oral herpes lesions but I did anyway, just no way of knowing for sure if it was herpes, stomatitis, or a bitten lip gone bad. I'm just thrilled it no longer hurts! It comes in a single use applicator (glofified Q-tip) and sells for around $6 each.

When I asked about it at my pharmacy they were clueless, as were two other local pharmacies. I eventually had to go to the pharmacy where my sister got it. Thankfully I was going to see her that weekend and it was handy for me. So, you might have trouble getting someone to find and order it for you.

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